Children are increasingly spending time indoors engaged with various forms of electronic devices: phones, computers, tablets, televisions, and gaming consoles. Parents and educators are often concerned that too much screen time is damaging to children. One study suggests that children can spend an average of seven hours per day in front of screens. While not all screen time is created equal, there are benefits to using media in educational settings, for example, there is no argument that children on the whole spend too much time engaged with electronic devices to be healthy.
What’s the solution? Get kids outdoors to improve their mental and physical health.
There is significant data indicating that time spent outdoors, whether in play, outdoor education or recreation, or even gardening, can have a real and positive impact on mental and physical well-being. Outdoor experiences included as adjuncts to classroom learning improve classroom performance. These types of experiences can also improve communication and social cues. Parks with green spaces and urban hiking areas promote creativity through play. Gardening teaches children about the food cycle and nutrition, provides important life skills, and creates opportunities for children to learn competence, resilience, and community building.
How can busy parents, who may themselves suffer from too much screen time, help kids get outdoors? Here are a few suggestions:
Gardening – Junior Master Gardener programs can be integrated into school curricula or be used at home or in religious youth groups. Children’s gardening programs ignite a passion for good food, provide opportunities for people of all ages to work together, and develop important life skills that can lead to a lifetime of healthful choices. Food produced may be used in home or school settings, canned for use in the off season, and excess donated to local food banks.
Scouts – Boy Scouts and Girl Scouts are values-based movements that each have an underpinning in outdoor programming. While certainly not all these groups do – they have science and community service activities among others – scout organizations often own or have access to outdoor properties and professionals that children would not have an opportunity to experience in other ways. Outdoor programs have a deep tradition within scouting and are offered in age-appropriate ways for the youngest and oldest scouts.
State and National Parks – State and national parks offer a wide variety of outdoor activities for youth and families. These are not necessarily just hikes or camping, but interactive wildlife activities, archaeological activities, storytelling times, and much more. The park service often coordinates activities with various scout groups too and provides special programming for youth groups from a variety of agencies and organizations. There are also free access days to National Parks that you can find out about online.
Agricultural Groups – Groups like 4H and Future Farmers of America (FFA) teach agriculture skills using project-based activities. 4H is the nation’s largest youth serving organization, providing leadership and skill building opportunities for youth and their communities. FFA is a school-based activity giving students a foundation in agriculture education.
Don’t allow children to trap themselves indoors spending mind-numbing hours watching screens. Take them to the park for unstructured play time. Give them chores that include working outdoors. If you live in a place where those kinds of activities are unsafe or you want your children to develop leadership and communication skills in addition to spending time outdoors, consider any of the organizations listed above or local groups that give children outdoor experiences.
By teaching children about gardening, ecosystems, and wildlife and giving them opportunities to work in a team with others, you will equip them with experiences and skills that will help them live healthier, more well-adjusted lives in the years to come. Outdoor experience often creates resilience – and we can all use much more of that.
February 3, 2018 Comments Off on Get Kids Outdoors to Improve Mental and Physical Wellbeing
We’re three weeks into the year and most of us have already given up on our resolutions. But giving up on resolutions should not mean giving up on leading healthier, more fulfilling lives. In fact, now is a great time to consider reasonable, pleasurable activities that will help us be fitter and happier.
Perhaps the easiest thing to do is to spend time outdoors.
There is mounting evidence that almost any outdoor activity will decrease stress and improve life satisfaction. Improvement in both mental and physical health can be attributed to spending time outdoors. Even something as simple as outdoor play can lead to positive health outcomes.
There are simple steps you can take to benefit from being outdoors. Why not try:
Gardening: The time to plant a spring garden is fast approaching. Check out gardening websites for your area or find a Master Gardener group. Even if you live in a densely populated city, you can grow plants indoors, use window boxes, or find neighborhood green space. Many food pantries around the nation have land plots where people can garden. Whether you grow food or flowers, putting your hands in soil will have positive mental health benefits.
Walking: The simplest activity anyone can participate in is going for a walk in a green space. Walking by yourself or with others can be both physically and emotionally invigorating. Walking can decrease your sweet tooth and improve your creativity. Walking outdoors, particularly in a natural setting, can help to put our problems in perspective. It can take our minds off the pettiness and smallness of so many of the issues we face. And let’s tell the truth – parks and nature trails smell nicer than the indoor track at the gym.
Outdoor Play: The benefits of outdoor play for children cannot be understated. Studies have shown that outdoor play can have a significant positive impact on children’s brain development. Unstructured outdoor play can help children develop social and problem-solving skills. As with adults, being outdoors has a positive mental health impact and reduces stress and anxiety. Whether playing with other children or with the family – walking, hiking, or bike riding – being outdoors together builds family and social bonds.
Chores: Yes, even outdoor chores can have positive mental and physical health benefits. Instead of seeing snow shoveling or garden watering as a bummer, make a game out of your outdoor duties. Shoveling off the sidewalk in front of an elderly person’s house will give you exercise and help you feel good about yourself. Chores are an opportunity for service.
Stargazing: This might not be the most fun in the dead of winter, but getting out of the light polluted city and going someplace truly dark where you can really see the stars is breathtaking and awe-inspiring. The universe is an incredible place to behold. Grab a telescope and thermos of coffee and take off to see the moon and beyond.
State and National Parks: Our state and national park systems are one of the treasures of this nation. To find local resources, search “state parks near me.” For our national park system, search for the National Park Service. At many locations, there are professional rangers or volunteer docents who will share with you the magic of our beautiful parks.
Don’t allow yourself to become a screen addict and a couch potato. Get outdoors and reap the many mental and physical health benefits that come from enjoying our beautiful planet.
January 22, 2018 Comments Off on Get Outside: One Difference that Makes a Difference for Improving Life Satisfaction
One of the problems with New Year’s resolutions is that most of us who make them aim too high. After at least a week of merry-making, starting with events before Christmas and culminating with New Year’s Day binges of sports and food, we suddenly expect ourselves to turn our lives around. We vow to go to the gym five days a week or switch to a paleo diet. We want to lose fifty or a hundred pounds and get in shape for summer. The reality, however, is that these changes are too drastic for us to be successful. Instead of expecting radical change in an instant, why not focus on smaller changes that can create big differences in our lives?
A resolution that is easy to implement and will have a significant impact on your life is to spend more time in green spaces and natural settings. According to the US Census Bureau, more than 62% of Americans live in cities and the trend is growing. Part of the reality of urban life is that most of us are not spending a lot of time outside or in green spaces; we go from home to transportation to work to other buildings and home again. This is a shame, because spending time in natural areas can have tremendous positive health benefits.
Research on the benefits of spending time in green spaces, especially for those who live in urban areas and may not have innate opportunities to be outside, is extensive. The International Journal of Wellbeing published a study indicating that regularly connecting with nature is a key activity in having a flourishing life. The Journal of Landscape and Urban Planning shared research showing how simply walking in a park can have a significant positive impact on well-being and encouraged the development of more green spaces in urban areas. Frontiers in Psychology published a study that found that spending time in nature or green spaces can help those with a variety of psychological disorders including but not limited to anxiety, depression, and attention deficits. Research in the Alternatives Journal concurs about the mental health benefits of spending time in green spaces and natural settings. That article even goes so far as to suggest that physicians and psychotherapists might do well to prescribe time outdoors for patients suffering from anxiety, depression, and many other mental health disorders. A study in the Journal of Environmental Psychology found that, “Being outdoors was associated with greater vitality, a relation that was mediated by the presence of natural elements.” There is no scientific dispute; spending time in parks and wild spaces makes us feel better.
What does this mean for New Year’s resolutions? Foremost, it means that we can make substantial improvements in our lives by making small changes. Set yourself up for success by making minor modifications to your lifestyle that you’re willing to stick to. While you might not be likely to go from junk-food-junkie to raw food vegan in one fell swoop, you are likely to be able to keep a commitment to take a walk in the park or eat your lunch under a tree on your break. You probably will take your kids for a bike ride or do a little gardening in the yard. Even these little changes can have a big impact. Then, as you begin to feel better, you can begin to tackle the larger issues you might want to address in your life.
This New Year, make a resolution that you are going to keep. Commit to spending at least twenty minutes a day outdoors in a green space. You might read a book, take a walk, practice tai chi, drink your coffee – whatever activity you choose is fine – just get outside and enjoy the beauty the world has to offer. You’ll feel and be better for it!
December 31, 2017 Comments Off on Go Where It’s Green: A New Year’s Resolution You Can Keep
Family gatherings can be difficult. All the emotional baggage and hurt feelings of the past can simmer beneath the surface. If allowed, these feelings can erupt in ugly ways. Here are a few tips to keep calm and help all family members enjoy their Thanksgiving dinner.
- Do not discuss politics. No one’s mind is going to be changed over dinner, but families can be permanently broken apart. Even if your politically-polarizing relative chides you, politely change the subject. Do not take the bait. There is nothing to be gained by discussing divisive topics.
- Do something nice for someone else. Show up Wednesday afternoon to help your grandmother put the leaf in the table and get the extra chairs from the attic. Drop off that old coat and knit hat at a collection place on your way to the airport. Make a donation to your local food bank or homeless shelter. One way to bring joy and give thanks for what you have is to help others who may not have the same gifts and blessings.
- Create a tradition of sharing gratitude. It might sound hokey, but having everyone share something for which they are grateful can sometimes put difficult family relations in perspective. It can also be an ice-breaker for those who are not accustomed to talking about their feelings. Reflecting on your blessings will improve your outlook and your patience.
- Lock up all medications. Millions of families are dealing with substance abuse and addiction. Unfortunately, Thanksgiving is a time when lots of people are in one place, which gives addicts an opportunity to steal medications. If someone at your Thanksgiving dinner has a problem with substance abuse, make sure all medications are locked away and are not accessible.
- Consider making your event alcohol free. Some people can’t imagine Thanksgiving dinner without alcohol. Others don’t really care one way or another. What is certain is that the more alcohol is involved in holiday gatherings, the more likely there are to be harsh words and broken relationships. Also, if you have someone in your family struggling with addiction or in early recovery, having an alcohol-free event can show your support for their recovery.
- Don’t judge. OK, so your great uncle is a loudmouth. Your niece’s boyfriend behaves in a way that is entitled, rude, and disrespectful. Your daughter is on some crazy diet and won’t eat anything you slaved over the stove for three days to make. Take a deep breath and remember why you are gathered. Focus on what is good instead of the irritations.
- Keep the visit brief. You are not required to spend the entire day with your family. If Thanksgiving is difficult, join the family for the meal and perhaps a short chat after and move on. Most people can be pleasant for an hour or two. Spend your time with those you rarely get to see, especially the elderly or the ill – and ask them how they are, instead of focusing on you.
November 22, 2017 Comments Off on Seven Tips for Enjoying a Family Thanksgiving Celebration
As an addiction treatment professional, it goes with the territory that we lose people, good people who maybe needed a little more help or time or who simply made a regrettable choice. Veterans are often among those lost to substance abuse and suicide.
My first and most devastating loss was of a young Marine, Scott,* who had returned to the US from multiple deployments in Iraq and Afghanistan. He was 23 and handsome, classic good looks – blonde hair, blue eyes, solid chin and impeccable manners. I like working with veterans and active duty military because I have yet to meet one without impeccable manners. When I knew Scott, he was living at a VA facility in California. Scott and I spoke often. He liked to watch me needlepoint. I understood Scott because although we had very different stories, we had both self-medicated our symptoms of post-traumatic stress. We were in a way, kindred spirits.
Scott had hoped for a career in the military, but had been wounded during his last deployment and could not continue in military service. He walked with a cane and was clearly in pain. Scott had a wife and a child that was only a few months old. He sought treatment at the VA for alcohol abuse related to post-traumatic stress disorder (PTSD).
The last time I saw Scott, he had arrived at the meeting hall earlier than normal. He sat in his usual chair at the end of the first row. He was shaking. I walked up to him right away and asked what was wrong. He told me that he had just come from therapy and was very upset. To treat trauma, the VA often uses exposure therapy. In this type of therapy, the individual recounts, and very often in their mind relives, the most traumatic experience(s) of their lives. Exposure therapy is the “gold-standard” for PTSD treatment, according to the VA.
Exposure therapy can be an effective tool for overcoming trauma-related symptoms. For example, if a woman was raped in a park, she may have a fear of going to a park – and this might prevent her from having a full relationship with her young child who likes parks. By reviewing the traumatic event in the park, the woman may be able to become desensitized and recognize that the trauma stems from an event, not from parks.
Unfortunately for some, there is no catharsis in reliving the worst moments of their lives. For these individuals, there is no desensitizing that goes on with exposure therapy. In fact, the therapy may exacerbate their PTSD symptoms. Scott did not benefit from exposure therapy. He did not tell his therapist that his PTSD symptoms were worsening. Rather than feeling he was a failure for discontinuing therapy or relapsing on alcohol to relieve his PTSD symptoms, Scott chose suicide as a way out of his pain.
Scott died nearly a decade ago. I didn’t know him well, but he was precious and he was pained. I think of him often, particularly on Veterans Day.
Could Scott have been saved? I don’t know. The VA certainly does its best. However, the staggering number of veteran suicides, now 20 per day down from 22 per day earlier in the decade, should indicate that we are not doing enough. Our services are either incomplete or inadequate, or not in the right places or veterans cannot or will not use them. Whatever the cause of the deficit, it is our responsibility to keep our promises to our wounded warriors of all types and do a better job of providing re-entry into our communities. We owe them a debt. We need to pay it.
*Not his real name.
November 11, 2017 Comments Off on To Honor Our Veterans, Let’s Keep Our Commitments to Them
It is clear with the latest healthcare proposal, the Senate’s Graham-Cassidy bill, that the GOP has no interest in genuine healthcare reform that would provide higher quality or less expensive health services to Americans. The proposal unremorsefully would decimate the quality of healthcare for millions of Americans, raise premiums, and make access to health insurance impossible for at least twenty million citizens. The Graham-Cassidy bill, which Senators hope to push through by the slimmest of votes, serves the purpose only of trying to eliminate Obama-era policies without any regard for the well-being of Americans. It is a heart-breaking effort most precisely because there is a chance that it could pass.
Today is Rosh Hashanah, the Jewish New Year and the beginning of a ten-day period of intense introspection that culminates with the holy day, Yom Kippur, the Day of Atonement. During this period, many Jews believe that the Book of Life is open. We pray to be inscribed for a good life and to be shown how we can live better. On Yom Kippur, when the Book of Life is sealed, we hope that our prayers and efforts to make important improvements in the way we live, will grant us mercy and strength to implement those changes through the year. It is not lost on me that the deadline for the Graham-Cassidy bill’s passage or defeat is also the day when our collective fate is sealed.
Bernie Sanders and his cohort have put out the call, again, to fill the phone lines with calls to Senators, demanding that they vote against this bill. No leading medical group supports the legislation. The medical groups I belong to are urging me once more to be sure that that my Senator votes against this legislation. Hasn’t the fact that similar proposals have failed twice already sent that message? It should have.
The Senate knows that Americans do not want this bill. I would rather, during this spiritually important period, devote myself to the charity work that calls so loudly – to evacuating people and livestock from the wildfires plaguing us here in the West; to collecting gift cards to support those devastated by hurricanes; to the food and coat drive that my synagogue runs to help our community as winter rolls in. I am frustrated. If our Senators can’t see that this is a deadly proposal, we need not waste our time showing them the fallacy of their ways. We need new Senators.
It is clear that the President’s base doesn’t like Obama. I completely understand that repeal of the Affordable Care Act was a rallying call for that base. We certainly can do better than the ACA, but until we can improve it, we cannot return to the days of pre-existing condition exclusions, annual or lifetime caps on coverage, enormous premium hikes, and lack of access to care for millions.
As I go to the synagogue to pray for a good year, I pray not only for myself, but for those who have no one to speak for them. I pray for the mentally ill and the addicts, the people I work with, who aren’t registered to vote and don’t have the ear of a Senator. The Torah commands that we choose life. It is for life, and for healthcare, that I pray. Senators, kill this bill before this legislation kills us.
September 21, 2017 Comments Off on Another Affordable Care Act Repeal Effort: The GOP’s Rosh Hashanah Prayer for American Deaths
Most of us who own horses talk about their “therapeutic” value. Being in the barn grooming, feeding, and otherwise caring for our horses reduces stress, lowers blood pressure and improves overall health. Yet, it is the companionship with our equine partners that is the foundation of our growth in relationship to these animals. Being with our horses is the “therapy.”
The power of this relationship has not been lost on medical professionals. “Equine therapy” is a popular tool to use with a variety of populations. But what is equine therapy and how is it used?
Equine Therapy Defined
According to PATH International, the Professional Association of Therapeutic Horsemanship, there are many different types of “equine assisted activities.” In its broadest sense, any interaction between a person and a horse is an equine assisted activity.
Equine-Assisted Therapy has a more specific goal. It is a treatment that uses horses to reach rehabilitative goals that are bounded by a medical professional’s scope of practice. Equine-Assisted Therapy is not an activity run by local horse clubs, church groups or trainers. Instead, it is overseen by a medical professional, usually a licensed psychotherapist or physical therapist. Equine-Facilitated Psychotherapy, which is used by addiction treatment facilities, veterans’ groups, and trauma centers, is always overseen by a licensed mental health professional. These types of therapies rarely involve riding the horse.
Benefits of Equine-Facilitated Psychotherapy
Especially for those who are unfamiliar with horses, working with horses can be an intimidating experience. Addicts, the population I work with, often exclaim, “They’re so big!” Indeed, as all horse-people know, trying to get a thousand-pound animal to do what you want is no easy task. If you are unaccustomed being honest and communicating clearly, the task becomes more difficult.
Horses can be an emotional mirror for humans. They respond to the feeling state we show. They are herd and prey animals, which means that they have a strong emotional sense and use this sense as a survival tool; they feed off of and respond to other horses in the herd. If one horse in a herd is scared, the others will become frightened. They respond similarly to humans. If a person approaches a horse with anger, the horse will respond by shying away or becoming stubborn. Horses never hide their emotions.
Because of these qualities, horses can be used to help people heal from a variety of psychological issues.
Identifying and Processing Feelings
First and foremost, horses can help individuals identify their feelings. Addicts in particular are known for numbing their feelings through the use of drugs and alcohol. When they get clean, they don’t know what to do with, or often how to identify, their feelings. This is a confusing and frustrating period for addicts. The horse, however, provides information to the client. If one walks angrily toward a horse, snatching its halter or lead, the horse will yank its head back and pull away. The therapist might ask the person, “What are you angry about?” Most of the time, the client will deny being angry and need to be shown the evidence of the horse’s behavior to identify the feeling. Addicts and other trauma survivors have to learn how to identify their emotions in order to work through them. Horses are a good tool for therapists to help clients do just that.
Horses can also open the door to re-visioning past traumatic events. Perhaps a plastic bag blows into the arena during a session, startling the horses. A client who has experienced child or domestic abuse might break down in tears upon seeing the horses frightened. It might remind him/her of experiences of powerlessness or helplessness, of being frightened, but having no-one to turn to. Any of these kinds of reactions is rich material for talk therapy and can be worked through immediately or in future sessions.
Horses require us to work. We get up early to feed and water. We clean stalls. We earn wages to buy feed and tack and maintain horse properties. Domestic horses have to be groomed, exercised, and attended to.
It is the same in the human world. Most of us have to work. Whether it is raising children or going to an office, factory or running a business, we get up early and show up on time. We participate in tasks that are not always easy or pleasant. We attend to our daily needs and those of others. We pay bills, clean the house, and keep the car in working order. We work hard and enjoy our moments of respite.
We also have to work to maintain our relationships. We listen to our friends, show up for our families, and provide service to our communities. Working hard and showing up in a healthy way are skills that can be learned by engaging with horses.
Horses are majestic animals that are wonderful simply to be with. Horses are gentle and honest; they do not have the ability to manipulate or lie. One common treatment technique for those who were abused as children is to put the (now adult) individual in with a large horse and allow them to interact. Very often, the person will break down in tears and say something like, “I’ve never been treated this kindly by anything so big.” This is an experience the client can then take into the human world.
Equine-Assisted Therapy, particularly Equine-Facilitated Psychotherapy, can have positive results for those who are recovering from substance abuse, trauma, depression, or a number of other psychological issues. It can help individuals develop a work ethic, identify and process feelings, and learn how to trust. However, to be safe and effective, Equine-Facilitated Psychotherapy must be provided by a licensed medical professional. As problematic feelings and memories arise, someone with experience helping people process those feelings must be present. The professionalism of those engaged with equine therapies is what makes them both effective and safe.
August 23, 2017 Comments Off on The Therapeutic Value of Horses
In response to his drug commission’s recommendation to declare the opioid overdose epidemic a national emergency, Trump demurred. Instead of taking the action his commission suggested, he spoke of ramping up law enforcement, in particular working to keep drugs from coming into the country. Trump blustered in favor what is already known to be a failed war on drugs policy, with no word at all about how to help the millions of Americans addicted to opioids right now.
The facts are startling. Every day an average of 142 Americans die from accidental overdose. In states across the nation, from Oregon to Ohio, to Florida, millions of children are in foster care because their parents are drug addicted and cannot care for them. In some states, as many as half the children in foster care are there because of parental substance abuse. Many others outside the foster care system live with family members who are not their parents. Whether through death or breaking up families, opioid addiction is tearing at the foundation of our homes.
A wall – to keep drugs or people out – doesn’t address the fundamental problem that we face. Opioid addiction wasn’t born out of an influx of drugs into the country. It was born out of an internal problem of overprescribing drugs that are unsafe for long-term use. Law enforcement aimed at international drug cartels does nothing to address this.
Help isn’t coming from the federal level. With that in mind, what then can we do, right now in our communities, to address the opioid overdose crisis?
The truth is that once you break up the family, the children are devastated and the addict loses motivation to recover. To keep families together, we have to focus on recovery.
First, stop the dying. All first responders and homes in which anyone uses opioids for more than a week need to have the opioid reversal drug, naloxone, on hand. Human decency demands that we save whomever we can. We also need to be able to offer quality addiction treatment of sufficient duration to allow people to recover. Now, there is a shortage of treatment beds available and those who can get treatment often are not allowed to stay more than a month before their insurance sends them home. Failing to invest in addiction treatment is failing to invest in families.
Second, address the crisis in foster care. There is no way around it. Children are victims of substance abuse and our foster care system is broken. Effort needs to be made to address system failures while more, good quality homes are opened up to children in need. Engaging clergy and faith-based organizations is the best place to start, to encourage loving families to make room for children with nowhere to go.
Third, advocate for quality state-run health exchanges that provide substance abuse treatment. While Trump and members of the GOP are hell-bent on undermining the Affordable Care Act, states must pick up the slack. This means being proactive and looking into ways to provide quality healthcare on a state-by-state basis.
Community based action that advocates for state-level changes is the only way forward. The federal government is stymied. We know what to do. Now, we have to roll up our sleeves and do it.
August 9, 2017 Comments Off on No, Mr. President, a Wall Won’t Stop Opioid Overdose Deaths
State Autonomy or Federal Negligence? Medicaid Cuts in the Fight Against Opioid Addiction
State and federal governments pay deeply for addiction. One study conducted by researchers at the National Center for Injury Prevention and Control estimates that the opioid addiction crisis has cost the United States more than $78 billion. The cost is staggering.
As President Trump and Congress consider deep cuts to Medicaid, a move designed to give states more freedom and curtail federal funding, public health advocates have to ask: is Trump’s proposed health care reform a nod to states’ independence or federal negligence to address a national addiction epidemic?
The dramatic decrease in funding key to Congress’ Medicaid reform proposal will have a ripple effect among the social service providers, institutions, individuals and families grappling with addiction. Most immediately, people looking for affordable addiction treatment services will struggle to find care. Nearly 30% of people covered by the Medicaid expansion overseen by President Obama are diagnosed with a mental health disorder or substance abuse disorder, accounting for more than 1.2 million Americans across the country. More than a million people will be denied access to life-saving treatment if the Medicaid expansion is retracted. Allowing hundreds of thousands of needy people to lose health coverage would be a national failure.
What services do remain accessible to people seeking addiction treatment will likely be determined based on cost, not efficacy. Medication-assisted treatment (MAT) for opioid dependence can be a clinically effective tool for treating opioid addiction, yet the high price of some MAT drugs like Suboxone may be enough to downsize states’ investments in this treatment modality. This includes Alaska and Kentucky, two of the states hit hardest by the opioid epidemic, where Medicaid pays for nearly 35% and 45% of all buprenorphine-assisted addiction treatment state wide, respectively. Forcing states to revoke health care coverage or specific treatments for people battling an addiction does not make states more independent or autonomous, but it does diminish states’ public services based on federal policy.
The impact of reduced funding for addiction treatment services on a state level will be tragic. With fewer resources to provide, fewer people will be able to access treatment when they need it the most, increasing the risk of accidental overdose. The Comprehensive Addiction Recovery Act (CARA) passed by Congress in 2016 identified first responders’ access to opioid overdose-reversal drug Naloxone as a key strategy for lowering opioid-related fatal overdoses. However, even this last resort intervention will not be secured for first responders until Congress passes a budget appropriating funds for CARA and all the services it outlines. States must wait on Washington to see if they’ll be provided with the necessary financial resources and support desperately needed to curb the opioid epidemic in their communities.
The relationship between states and the federal government on this issue doesn’t need to be complicated. States should be free to respond to their communities’ public health crises, including addiction, as they see fit. Where the federal government can provide much needed financial support to states in their efforts to prevent and treat addiction, particularly addictions to opioid-based pain killers, they have an obligation to do so. Funding effective addiction treatment should be a bipartisan issue.
April 25, 2017 Comments Off on State Autonomy or Federal Negligence? Medicaid Cuts in the Fight Against Opioid Addiction
The Impact of the Proposed Republican Reforms to the Affordable Care Act
Americans have gotten their first glimpse of proposed Republican reforms to the Affordable Care Act (ACA) and the news is not good for those who suffer from addiction and other vulnerable populations. The changes could make it impossible for many who currently have access to care to get treatment in the future, reversing the progress made by the ACA. The result, if the changes pass Congress, will mean a loss of life.
There is some good news in the Republican proposal. Some of the most important and popular aspects of the ACA will be retained. These include: 1) Young adults up to the age of 26 will be able to stay on their parents’ healthcare plan; 2) There will be no return to lifetime caps on healthcare; 3) There will be no return to “pre-existing” conditions. These are critical healthcare reforms that protect those who have health insurance, especially those who access health insurance through their employers.
The proposed changes to the healthcare system mainly come in the area of funding: who can access health insurance and how it will be paid for. In this regard, the changes are less positive, particularly for the poor and the aging.
One aspect of the ACA under attack by Republicans is Medicaid expansion. Under Obama, many states were able to expand Medicaid coverage. Some of those states, like Ohio, are among those that have been hardest hit by the opioid abuse epidemic.
Medicaid is currently funded on a flexible basis. States are paid based on the number of poor who are covered through the program. When the economy lags or a state has an increase in the number of people qualifying for Medicaid for other reasons, the federal government increases funding to pick up the slack. Medicaid is a true safety net under this system.
The current administration wants to change Medicaid funding to a block grant system. With block grants, the federal government pledges a specific amount of money to each state. This amount does not change based on need and is re-evaluated at three year intervals. In times when the economy lags, it is likely that the federal government will decrease funding to states, rather than increase it as the current system does. Most block grant funded programs atrophy. As federal Medicaid funding becomes increasingly unavailable, states that are unable to make up the losses will have larger and larger numbers of people without Medicaid coverage.
Older Americans will also suffer under this proposed ACA revision. Caps on how much insurance companies are able to charge older adults will significantly increase and although tax credits will switch from assisting the poorest Americans to assisting older Americans, it is unclear that these tax credits will cover the skyrocketing premiums older Americans will face.
These changes to the ACA are not a foregone conclusion. There is opposition among the farthest right wing of the Republican party, medical doctors and hospital associations, and elder rights advocates. At present, the legislation could not pass the Senate. To retain your healthcare coverage and that of the most vulnerable Americans, let your Senator know where you stand and that you vote.
April 25, 2017 Comments Off on The Impact of the Proposed Republican Reforms to the Affordable Care Act